I 

115TH CONGRESS 

2D SESSION H. R. 6097 

To amend title I of the Patient Protection and Affordable Care Act to 

authorize the establishment of, and provide support for, State-based 

universal health care systems that provide comprehensive health benefits 

to State residents, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 13, 2018 

Ms. JAYAPAL (for herself, Ms. SCHAKOWSKY, and Mr. POCAN) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight 

and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each 

case for consideration of such provisions as fall within the jurisdiction of 

the committee concerned 

A BILL 

To amend title I of the Patient Protection and Affordable 

Care Act to authorize the establishment of, and provide 

support for, State-based universal health care systems 

that provide comprehensive health benefits to State residents, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; PURPOSE. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘State-Based Universal Health Care Act of 2018’’. 


amozie on DSK3GDR082PROD with BILLS
2 

•HR 6097 IH

1 (b) PURPOSE.—The purpose of this Act is to estab2 lish a flexible framework under which States can provide 

3 comprehensive universal health coverage to all of their 

4 residents. 

5 SEC. 2. WAIVER FOR STATE UNIVERSAL HEALTH CARE. 

6 (a) IN GENERAL.—Title I of the Patient Protection 

7 and Affordable Care Act (Public Law 111–148) is amend8 ed by striking section 1332 (42 U.S.C. 18052) and insert9 ing the following new section: 

10 ‘‘SEC. 1332. WAIVER FOR STATE UNIVERSAL HEALTH CARE. 

11 ‘‘(a) APPLICATION.— 

12 ‘‘(1) IN GENERAL.—A State may apply to the 

13 Secretary (as defined in subsection (i)(3)) for the 

14 waiver of so much of the requirements described in 

15 paragraph (2) with respect to health benefits cov16 erage within that State for plan years beginning on 

17 or after January 1, 2019, as is necessary to imple18 ment a comprehensive State universal health care 

19 plan in the State under this section. Such applica20 tion shall— 

21 ‘‘(A) be filed at such time and in such 

22 manner as the Secretary may require; 

23 ‘‘(B) contain such information as the Sec24 retary may require, including— 


amozie on DSK3GDR082PROD with BILLS
3 

•HR 6097 IH

1 ‘‘(i) a comprehensive description of 

2 the State legislation and program to imple3 ment a plan meeting the requirements for 

4 a waiver under this section; 

5 ‘‘(ii) a plan for how the State will 

6 achieve in 5 years health coverage for at 

7 least 95 percent of the population of the 

8 State, with five percent of the population 

9 of the State not spending more than 10 

10 percent of their adjusted gross income on 

11 health; and 

12 ‘‘(iii) a 10-fiscal-year budget plan for 

13 such plan that is budget neutral for the 

14 Federal Government; and 

15 ‘‘(C) provide an assurance that the State 

16 has enacted, or will be enacting before the cur17 rent State legislative session adjourns, the law 

18 described in subsection (b)(2). 

19 ‘‘(2) REQUIREMENTS.—The requirements de20 scribed in this paragraph with respect to health ben21 efits coverage within the State for plan years begin22 ning on or after January 1, 2019, are as follows: 

23 ‘‘(A) Parts I, II, and III of this subtitle. 

24 ‘‘(B) Section 1402. 


amozie on DSK3GDR082PROD with BILLS
4 

•HR 6097 IH

1 ‘‘(C) Sections 36B and 4980H of the In2 ternal Revenue Code of 1986. 

3 ‘‘(D) Title XI of the Social Security Act. 

4 ‘‘(E) Title XVIII of the Social Security 

5 Act. 

6 ‘‘(F) Title XIX of the Social Security Act. 

7 ‘‘(G) Title XXI of the Social Security Act. 

8 ‘‘(H) Chapter 89 of title 5 of the United 

9 States Code. 

10 ‘‘(I) Chapter 55 of title 10, United States 

11 Code, including coverage under the TRICARE 

12 program. 

13 ‘‘(J) Section 514 of the Employee Retire14 ment Income Security Act of 1974. 

15 ‘‘(3) PASS THROUGH OF FUNDING.—With re16 spect to a State waiver under paragraph (1), under 

17 which the State assumes responsibility for health 

18 coverage under a specified Federal health program, 

19 including under each of the Federal health care or 

20 subsidy programs specified in subparagraphs (B), 

21 (C), (E), (F), (G), and (H) of paragraph (2), the 

22 Secretary shall not spend Federal health funds that 

23 would otherwise have been spent for such program 

24 and shall provide for an alternative means by which 

25 the aggregate amount of such funds shall be paid to 


amozie on DSK3GDR082PROD with BILLS
5 

•HR 6097 IH

1 the State for purposes of implementing the State 

2 plan under the waiver. Such amount shall be deter3 mined annually by the Secretary, taking into ac4 count the amount that would otherwise have been 

5 spent under such Federal health program with re6 spect to residents of such State, if such waiver did 

7 not apply. Such amount shall include funds equal to 

8 the amount of premium tax credits, cost-sharing re9 ductions, or small-business credits under sections 

10 36B and 45R of the Internal Revenue Code of 1986 

11 or under section 1402 that would have been avail12 able to individuals and businesses in the State if 

13 such waiver did not apply. 

14 ‘‘(4) WAIVER CONSIDERATION AND TRANS15 PARENCY.— 

16 ‘‘(A) IN GENERAL.—An application for a 

17 waiver under this section shall be considered by 

18 the Secretary, after taking into account rec19 ommendations of the Panel under subsection 

20 (g), in accordance with the regulations de21 scribed in subparagraph (B). 

22 ‘‘(B) REGULATIONS.—Not later than 180 

23 days after the date of enactment of the State24 Based Universal Health Care Act of 2017, the 


amozie on DSK3GDR082PROD with BILLS
6 

•HR 6097 IH

1 Secretary shall promulgate regulations relating 

2 to waivers under this section that provide— 

3 ‘‘(i) a process for public notice and 

4 comment in accordance with the public no5 tice and comment requirements applicable 

6 under regulations used for Medicaid waiv7 ers pursuant to section 1115 of the Social 

8 Security Act; 

9 ‘‘(ii) a process for the submission of 

10 an application that ensures the disclosure 

11 of— 

12 ‘‘(I) the provisions of law that 

13 the State involved seeks to waive; and 

14 ‘‘(II) the specific plans of the 

15 State to ensure that the waiver will be 

16 in compliance with subsection (b); 

17 ‘‘(iii) a process for providing public 

18 notice and comment after the application is 

19 received by the Secretary, that is sufficient 

20 to ensure a meaningful level of public 

21 input and that does not impose require22 ments that are in addition to, or duplica23 tive of, requirements imposed under the 

24 Administrative Procedure Act, or require25 ments that are unreasonable or unnecesVerDate Sep 11 2014 21:24 Jun 18, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6097.IH H6097

amozie on DSK3GDR082PROD with BILLS
7 

•HR 6097 IH

1 sarily burdensome with respect to State 

2 compliance; 

3 ‘‘(iv) a process for the Panel under 

4 subsection (g) to consider the applications 

5 for waivers so submitted and provide rec6 ommendations with respect to such appli7 cations; 

8 ‘‘(v) a process for the submission to 

9 the Secretary of periodic reports by the 

10 State concerning the implementation of the 

11 program under the waiver; 

12 ‘‘(vi) a process for the periodic evalua13 tion by the Secretary with respect to waiv14 ers granted under this section; and 

15 ‘‘(vii) a process for providing technical 

16 assistance on— 

17 ‘‘(I) how to develop an applica18 tion to any State seeking to submit an 

19 application for a waiver relating to de20 veloping a program of providing 

21 health care for all residents for such 

22 State; and 

23 ‘‘(II) how to improve such a pro24 gram for purposes of a State seeking 


amozie on DSK3GDR082PROD with BILLS
8 

•HR 6097 IH

1 assistance pursuant to subsection 

2 (e)(2). 

3 ‘‘(C) REPORT.—The Secretary shall annu4 ally report to Congress concerning actions 

5 taken by the Secretary with respect to applica6 tions for waivers, and programs conducted 

7 through waivers granted, under this section. 

8 Each such report shall include, with respect to 

9 any action by the Secretary so taken, with re10 spect to an application, that was not consistent 

11 with the recommendations of the Panel under 

12 subsection (g), with respect to such application, 

13 the reasons such action was taken. 

14 ‘‘(5) REGIONAL WAIVER REQUEST AND PLAN.— 

15 Nothing in this section shall be construed to prevent 

16 two or more States in a region from submitting a 

17 single application under this section for a waiver 

18 that establishes a plan that is applicable to all of the 

19 States included in such application. In the case of 

20 such an application and plan, the requirements of 

21 this section shall continue to be applicable with re22 spect to each State included in such application. 

23 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 

24 There is authorized to be appropriated such sums as 

25 may be necessary for providing funds to States with 


amozie on DSK3GDR082PROD with BILLS
9 

•HR 6097 IH

1 a waiver under this section for purposes of carrying 

2 out activities described in subsection (b)(1)(E). 

3 ‘‘(b) GRANTING OF WAIVERS.— 

4 ‘‘(1) IN GENERAL.—The Secretary may grant a 

5 request for a waiver under subsection (a)(1) only if 

6 the Secretary determines that the State plan— 

7 ‘‘(A) will provide, in accordance with sub8 paragraph (B), health benefits coverage to 

9 State residents that is at least as comprehen10 sive as the health benefits coverage that such 

11 residents would have received under the speci12 fied Federal health program (as defined in sub13 section (i)(4)) for which such residents would 

14 have been eligible, absent such waiver; 

15 ‘‘(B) will provide, in the case of such a 

16 waiver under subsection (a)(1) for the State to 

17 waive any of the requirements described in sub18 section (a)(2)(F), health benefits coverage to 

19 State residents who would have otherwise re20 ceived health benefits coverage in the form of 

21 medical assistance under the State Federal 

22 health program described in subsection 

23 (i)(4)(B) (regardless of whether the State pro24 vides for such assistance through a State plan 

25 under title XIX of the Social Security Act or a 


amozie on DSK3GDR082PROD with BILLS
10 

•HR 6097 IH

1 waiver of such plan) that includes at least the 

2 mandatory benefits under title XIX of the So3 cial Security Act that are required of a State 

4 without a waiver of a State plan under such 

5 title, including at least benefits for early and 

6 periodic screening, diagnostic, and treatment; 

7 benefits for non-emergency transportation; and 

8 retroactive coverage; 

9 ‘‘(C) will provide coverage and cost sharing 

10 protections against excessive out-of-pocket 

11 spending to State residents that are at least as 

12 affordable as the coverage and cost sharing pro13 tections under the specified Federal health pro14 gram (as defined in subsection (i)(4)) for which 

15 such residents would have been eligible, absent 

16 such waiver; 

17 ‘‘(D) will provide coverage to all residents 

18 of the State, including all those otherwise cov19 ered under the Federal health care or subsidy 

20 programs specified in subparagraphs (B), (C), 

21 (E), (F), (G), and (H) of subsection (a)(2), ex22 cept individuals who are eligible for benefits 

23 through the Indian Health Service or for bene24 fits and services under title 38, United States 

25 Code; 


amozie on DSK3GDR082PROD with BILLS
11 

•HR 6097 IH

1 ‘‘(E) will provide for public education ac2 tivities to raise awareness of the availability of 

3 qualified health plans and the facilitation of en4 rollment in such coverage in a manner similar 

5 to an entity that serves as a navigator under a 

6 grant under section 1311(i); 

7 ‘‘(F) will be publicly administered by an 

8 agency of the State; 

9 ‘‘(G) will not preclude the purchase of sup10 plemental insurance; 

11 ‘‘(H) will provide systems for complaints, 

12 appeals, independent review, and other proce13 dures for accessing and maintaining benefits 

14 that are at least as accessible to State residents 

15 as those of the specified Federal health pro16 grams (as defined in subsection (i)(4)) for 

17 which such residents would have otherwise been 

18 eligible without application of such waiver 

19 under subsection (a)(1); and 

20 ‘‘(I) will not increase the Federal deficit. 

21 Subparagraph (D) shall not be construed as limiting 

22 a State from contracting with one or more private 

23 entities to administer the plan. 

24 ‘‘(2) REQUIREMENT TO ENACT A LAW.— 


amozie on DSK3GDR082PROD with BILLS
12 

•HR 6097 IH

1 ‘‘(A) IN GENERAL.—A law described in 

2 this paragraph is a State law that provides for 

3 State actions under a waiver under this section, 

4 including the implementation of the State plan 

5 under subsection (a)(1)(B). 

6 ‘‘(B) TERMINATION OF OPT OUT.—A State 

7 may repeal a law described in subparagraph (A) 

8 and terminate the authority provided under the 

9 waiver with respect to the State. 

10 ‘‘(c) SCOPE OF WAIVER.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall deter12 mine the scope of a waiver of a requirement de13 scribed in subsection (a)(2) granted to a State under 

14 subsection (a)(1). 

15 ‘‘(2) LIMITATION.—Under this section, the Sec16 retary may not waive any Federal law or require17 ment that is not listed in subsection (a)(2). 

18 ‘‘(d) DETERMINATIONS BY SECRETARY.— 

19 ‘‘(1) TIME FOR DETERMINATION.—The Sec20 retary shall, with respect to an application from a 

21 State under this subsection and after taking into ac22 count recommendations of the Panel under sub23 section (g) for such application, make a determina24 tion under subsection (a)(1) not later than 90 days 

25 after the receipt of such recommendations. 


amozie on DSK3GDR082PROD with BILLS
13 

•HR 6097 IH

1 ‘‘(2) EFFECT OF DETERMINATION.— 

2 ‘‘(A) GRANTING OF WAIVERS.—If the Sec3 retary determines to grant a waiver under sub4 section (a)(1), the Secretary shall notify the 

5 State involved of such determination and the 

6 terms and effectiveness of such waiver. 

7 ‘‘(B) DENIAL OF WAIVER.—If the Sec8 retary determines a waiver should not be grant9 ed under subsection (a)(1), the Secretary shall 

10 notify the State involved and the appropriate 

11 committees of Congress of such determination 

12 and the reasons therefor. 

13 ‘‘(e) REQUIRED REPORTS; 5-YEAR REVIEW.— 

14 ‘‘(1) IN GENERAL.—As a condition of receipt of 

15 a waiver under this section, after each 5-year period 

16 of such waiver, a State shall submit to the Secretary 

17 a report that is carried out by an independent, non18 partisan entity, with respect to such 5-year period 

19 and after a process for public notice and comment 

20 at the State level, including public hearings, suffi21 cient to ensure a meaningful level of public input, on 

22 the following: 

23 ‘‘(A) How waiver funds have been spent by 

24 the State. 


amozie on DSK3GDR082PROD with BILLS
14 

•HR 6097 IH

1 ‘‘(B) The number of residents of the State 

2 without health insurance and a description of 

3 how the State plans to provide health insurance 

4 coverage within the subsequent 5 years to resi5 dents of the State without health insurance. 

6 ‘‘(C) How affordability in the State for 

7 health care has changed over the period. 

8 ‘‘(D) Whether the State has achieved 

9 health coverage for at least 95 percent of the 

10 population of the State. 

11 ‘‘(E) Any additional information specified 

12 by the Secretary for purposes of determining 

13 the successes and challenges of the waiver. 

14 ‘‘(2) 5-YEAR REVIEW.—In the case a State, 

15 based on the report submitted under paragraph (1) 

16 for a 5-year period— 

17 ‘‘(A) has been determined by the Sec18 retary, after taking into account recommenda19 tions of the Panel under subsection (g), to have 

20 not achieved health coverage for at least 95 per21 cent of the population of the State— 

22 ‘‘(i) the State shall have access to 

23 technical assistance described in subsection 

24 (a)(4)(B)(vii) to improve the health insurVerDate Sep 11 2014 22:49 Jun 18, 2018 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6097.IH H6097

amozie on DSK3GDR082PROD with BILLS
15 

•HR 6097 IH

1 ance program of the State implemented 

2 through the waiver under this section; 

3 ‘‘(ii) the State shall have a grace pe4 riod of 6 months after such determination 

5 to achieve health coverage for at least 95 

6 percent of such population; and 

7 ‘‘(iii) if after such 6 months, the State 

8 has not achieved such health coverage, the 

9 waiver under this section shall be termi10 nated; and 

11 ‘‘(B) has been determined by the Sec12 retary, after taking into account recommenda13 tions of the Panel under subsection (g), to have 

14 achieved health coverage for at least 95 percent 

15 of the population of the State, the State, as a 

16 condition of continuing such waiver, shall sub17 mit to the Secretary a plan for achieving health 

18 coverage for the remainder of the population of 

19 the State. 

20 ‘‘(f) ASSURING COORDINATION.— 

21 ‘‘(1) IN GENERAL.—Not later than 180 days 

22 after the enactment of the State-Based Universal 

23 Health Care Act of 2018, the Secretary of Health 

24 and Human Services, the Secretary of the Treasury, 

25 the Director of the Office of Personnel Management, 


amozie on DSK3GDR082PROD with BILLS
16 

•HR 6097 IH

1 the Secretary of Defense, and the Secretary of 

2 Labor shall, through the execution of an interagency 

3 memorandum of understanding among such Secre4 taries and the Director— 

5 ‘‘(A) develop a process for coordinating 

6 and consolidating the State waiver processes 

7 applicable under the provisions of this section, 

8 and the existing waiver processes applicable 

9 under— 

10 ‘‘(i) titles XI, XVIII, XIX, and XXI 

11 of the Social Security Act; and 

12 ‘‘(ii) any other Federal law relating to 

13 the provision of health care items or serv14 ices; and 

15 ‘‘(B) ensure that— 

16 ‘‘(i) regulations (including regulations 

17 required under subsection (a)(4)(B)), rul18 ings, and interpretations issued by such 

19 Secretaries and the Director relating to the 

20 same matter over which two or more such 

21 Secretaries or Director have responsibility 

22 under this section are administered so as 

23 to have the same effect at all times; and 

24 ‘‘(ii) coordination of policies relating 

25 to the granting, implementation, and conVerDate Sep 11 2014 21:24 Jun 18, 2018 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H6097.IH H6097

amozie on DSK3GDR082PROD with BILLS
17 

•HR 6097 IH

1 tinuation of waivers through such Secre2 taries and Director in order to have a co3 ordinated strategy that avoids duplication 

4 of effort by the States or Secretaries and 

5 Director and ensures clarity about waiver 

6 application status and approval. 

7 ‘‘(2) SINGLE APPLICATION.—The process under 

8 paragraph (1)(A) shall permit a State to submit a 

9 single application for a waiver under all of the provi10 sions of this section and the provisions of law listed 

11 under clauses (i) and (ii) of such paragraph. 

12 ‘‘(3) SUBMISSION OF CONFORMING AMEND13 MENTS.—The Secretary of Health and Human Serv14 ices, in coordination with the other Secretaries (in15 cluding the Director of the Office of Personnel Man16 agement), shall submit to Congress such rec17 ommendations for such technical and conforming 

18 amendments to law as may be appropriate to assist 

19 in the implementation of this section. 

20 ‘‘(g) INDEPENDENT ASSESSMENT PANEL FOR COM21 PREHENSIVE HEALTH CARE.— 

22 ‘‘(1) ESTABLISHMENT.—There is established a 

23 committee to be known as the ‘Independent Assess24 ment Panel for Comprehensive Health Care’ (in this 

25 section referred to as the ‘Panel’). 


amozie on DSK3GDR082PROD with BILLS
18 

•HR 6097 IH

1 ‘‘(2) CONSIDERATION OF SUBMISSIONS.—The 

2 Secretary shall forward a copy of each waiver appli3 cation submitted under this section to the Panel for 

4 consideration under this subsection. 

5 ‘‘(3) DUTIES.—The Panel shall— 

6 ‘‘(A) review any waiver application by a 

7 State forwarded under paragraph (2) and any 

8 report submitted under paragraph (1) of sub9 section (e) for purposes of the review under 

10 paragraph (2) of such subsection; 

11 ‘‘(B) not later than 90 days after submis12 sion of such application (or report) by the 

13 State, provide to the State and to the Secretary 

14 the recommendations of the Panel regarding 

15 the approval or disapproval of such waiver ap16 plication (or regarding the status of the waiver 

17 for continuation pursuant to subsection (e)(2)) 

18 and, if applicable, possible improvements to 

19 such application (or for purposes of subsection 

20 (e)(2)); and 

21 ‘‘(C) submit to Congress an annual report 

22 on waiver applications (and waiver reports 

23 under subsection (e)) reviewed by the Panel 

24 during the applicable year, including the num25 ber of applications (and reports) received and 


amozie on DSK3GDR082PROD with BILLS
19 

•HR 6097 IH

1 the number of applications recommended for 

2 approval (and of reports with respect to which 

3 recommendations for continuation were pro4 vided). 

5 ‘‘(4) MEMBERSHIP.— 

6 ‘‘(A) NUMBER AND APPOINTMENT.—The 

7 Panel shall consist of seven members appointed 

8 by the Secretary of Health and Human Serv9 ices, of whom— 

10 ‘‘(i) one shall be appointed on the rec11 ommendation of the Speaker of the House 

12 of Representatives; 

13 ‘‘(ii) one shall be appointed on the 

14 recommendation of the minority leader of 

15 the House of Representatives; 

16 ‘‘(iii) one shall be appointed on the 

17 recommendation of the majority leader of 

18 the Senate; 

19 ‘‘(iv) one shall be appointed on the 

20 recommendation of the minority leader of 

21 the Senate; 

22 ‘‘(v) one shall be appointed from the 

23 Republican Governors Association; 

24 ‘‘(vi) one shall be appointed from the 

25 Democratic Governors Association; and 


amozie on DSK3GDR082PROD with BILLS
20 

•HR 6097 IH

1 ‘‘(vii) one shall be a representative 

2 from the consumer advocacy community. 

3 ‘‘(B) TERM OF SERVICE.— 

4 ‘‘(i) IN GENERAL.—Each member of 

5 the Panel shall serve a three-year term. A 

6 member may serve after the expiration of 

7 that member’s term until a successor has 

8 been appointed pursuant to subparagraph 

9 (A). 

10 ‘‘(ii) VACANCY.—Any member ap11 pointed to fill a vacancy occurring before 

12 the expiration of the term for which the 

13 member’s predecessor was appointed shall 

14 be appointed only for the remainder of that 

15 term. A vacancy in the Commission shall 

16 be filled in the manner in which the origi17 nal appointment was made. 

18 ‘‘(C) PAY.—Members of the Panel shall 

19 serve without pay. 

20 ‘‘(D) CHAIRPERSON; VICE CHAIR21 PERSON.— 

22 ‘‘(i) CHAIRPERSON.—The Secretary of 

23 Health and Human Services, or a designee 

24 of the Secretary, shall serve on the Panel 

25 as the Chairperson of the Panel. 


amozie on DSK3GDR082PROD with BILLS
21 

•HR 6097 IH

1 ‘‘(ii) VICE CHAIRPERSON.—The Ad2 ministrator of the Federal Emergency 

3 Management Agency, or a designee of the 

4 Administrator, shall serve on the Panel as 

5 the Vice Chairperson of the Panel. 

6 ‘‘(5) STAFF, EXPERTS, AND CONSULTANTS.— 

7 The Panel may— 

8 ‘‘(A) appoint such staff as the Panel con9 siders to be appropriate, without regard to the 

10 provisions of title 5, United States Code, gov11 erning appointments in the competitive service; 

12 ‘‘(B) fix the pay of such staff, without re13 gard to the provisions of chapter 51 and sub14 chapter III of chapter 53 of such title relating 

15 to classification and General Schedule pay 

16 rates; and 

17 ‘‘(C) procure the services of experts and 

18 consultants in accordance with the provisions of 

19 section 3109(b) of such title. 

20 ‘‘(6) DETAIL OF FEDERAL PERSONNEL.—Upon 

21 request of the Panel, the head of any Federal agency 

22 may detail, on a reimbursable basis, any of the per23 sonnel of the agency to the Panel to assist it in car24 rying out the duties under paragraph (3). 


amozie on DSK3GDR082PROD with BILLS
22 

•HR 6097 IH

1 ‘‘(7) FEDERAL ADVISORY COMMITTEE ACT.— 

2 The Federal Advisory Committee Act (5 U.S.C. 

3 App.) shall apply to the Panel. 

4 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.— 

5 There is authorized to be appropriated such sums as 

6 may be necessary to the Panel for carrying out the 

7 duties of the panel for each of fiscal years 2018 

8 through 2023. 

9 ‘‘(h) GUIDANCE RELATING TO AMERICAN INDIANS

10 AND ALASKA NATIVES.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall issue 

12 guidance with respect to applying the provisions of 

13 this section in a manner consistent with the fol14 lowing: 

15 ‘‘(A) To further the goal that Federal 

16 health services to maintain and improve the 

17 health of the Indians are consonant with and 

18 required by the Federal Government’s historical 

19 and unique legal relationship with, and result20 ing responsibility to, the American Indian peo21 ple. 

22 ‘‘(B) No enrollment fee, premium, or simi23 lar charge, and no deduction, copayment, cost 

24 sharing, or similar charge is to be imposed 

25 against an Indian who is furnished an item or 


amozie on DSK3GDR082PROD with BILLS
23 

•HR 6097 IH

1 service through a waiver under this section. All 

2 costs incurred in waiving such charges shall be 

3 borne by the Federal Government in fulfillment 

4 of the trust responsibility. 

5 ‘‘(C) A State may not require the enroll6 ment of an individual who is an Indian in 

7 health insurance offered through a waiver under 

8 this section. 

9 ‘‘(D) Health insurance issuers offering cov10 erage pursuant to a waiver under this section 

11 must make good faith efforts to contract with 

12 Indian Health Care Providers operating within 

13 the area served by the issuers. 

14 ‘‘(E) Health insurance issuers offering cov15 erage pursuant to a waiver under this section 

16 shall pay Indian Health Care Providers, wheth17 er such providers are participating or non18 participating providers with respect to the cov19 erage, for covered services provided to those In20 dian enrollees who are eligible to receive serv21 ices from such providers at a rate equal to the 

22 rate negotiated between such entity and the 

23 provider involved or, if such a rate has not been 

24 negotiated, at a rate that is not less than the 

25 level and amount of payment which the entity 


amozie on DSK3GDR082PROD with BILLS
24 

•HR 6097 IH

1 would make for the services if the services were 

2 furnished by a participating provider which is 

3 not an Indian Health Care Provider. 

4 ‘‘(F) Health insurance issuers offering cov5 erage pursuant to a waiver under this section 

6 will include a standard contract addendum 

7 when contracting with Indian Health Care Pro8 viders. The contract addendum will be devel9 oped in consultation with tribes and in con10 ference with Urban Indian Health Programs 

11 operating within the service area of the State. 

12 ‘‘(G) The treatment of Indians under this 

13 legislation does not constitute invidious racial 

14 discrimination in violation of the Due Process 

15 Clause of the Fifth or Fourteenth Amendments, 

16 but is reasonable and rationally designed to fur17 ther the health of Indians. 

18 ‘‘(H) In the case of any State in which 1 

19 or more Indian Health Care Programs fur20 nishes health care services, the State will pro21 vide for a process under which the State seeks 

22 advice on a regular, ongoing basis from des23 ignees of such Indian Health Care Programs 

24 and Urban Indian Organizations on matters re25 lating to the application of a waiver under this 


amozie on DSK3GDR082PROD with BILLS
25 

•HR 6097 IH

1 section that are likely to have a direct effect on 

2 such Indian Health Programs and that— 

3 ‘‘(i) shall include solicitation of advice 

4 prior to submission of any plan amend5 ments, waiver requests, and proposals for 

6 demonstration projects likely to have a di7 rect effect on Indians or Indian Health 

8 Care Programs; and 

9 ‘‘(ii) may include appointment of an 

10 advisory committee and of a designee of 

11 such Indian Health Care Programs to the 

12 medical care advisory committee advising 

13 the State on its waiver under this section. 

14 ‘‘(2) DEFINITIONS.—For purposes of this sub15 section: 

16 ‘‘(A) The term ‘Indian’ has the meaning 

17 given such term in section 447.50 of title 42 of 

18 the Code of Federal Regulations (as in effect on 

19 July 1, 2010). 

20 ‘‘(B) The term ‘Indian Health Care Pro21 vider’ has the meaning given such term in sec22 tion 438.14(a) of title 42 of the Code of Fed23 eral Regulations. 

24 ‘‘(i) DEFINITIONS.—In this section: 


amozie on DSK3GDR082PROD with BILLS
26 

•HR 6097 IH

1 ‘‘(1) HEALTH BENEFITS COVERAGE.—The term 

2 ‘health benefits coverage’— 

3 ‘‘(A) means— 

4 ‘‘(i) health insurance coverage, as 

5 such term is defined in section 2791(b) of 

6 the Public Health Service Act (42 U.S.C. 

7 300gg–91(b)); and 

8 ‘‘(ii) coverage under a group health 

9 plan, as such term is defined in section 

10 2791(a) of the Public Health Service Act 

11 (42 U.S.C. 300gg–91(a)); and 

12 ‘‘(B) includes any medical coverage or 

13 health benefits provided under any specified 

14 Federal health program described in subpara15 graphs (A) through (E) of paragraph (4). 

16 ‘‘(2) RESIDENT.—With respect to a State, the 

17 term ‘resident’ means an individual— 

18 ‘‘(A) who is— 

19 ‘‘(i) a citizen or national of the United 

20 States; or 

21 ‘‘(ii) an alien lawfully residing in the 

22 State (including an alien who is granted 

23 deferred action or who is otherwise author24 ized to remain in the United States); and 


amozie on DSK3GDR082PROD with BILLS
27 

•HR 6097 IH

1 ‘‘(B) whose primary residence (as defined 

2 by the State) is located in the State. 

3 ‘‘(3) SECRETARY.—The term ‘Secretary’ 

4 means— 

5 ‘‘(A) the Secretary of Health and Human 

6 Services with respect to waivers relating to the 

7 provisions described in subparagraphs (A), (B), 

8 and (D) through (G) of paragraph (2) of sub9 section (a); 

10 ‘‘(B) the Secretary of the Treasury with 

11 respect to waivers relating to the provisions de12 scribed in subparagraph (C) of such paragraph; 

13 ‘‘(C) the Director of the Office of Per14 sonnel Management with respect to waivers re15 lating to the provisions described in subpara16 graph (H) of such paragraph; 

17 ‘‘(D) the Secretary of Defense with respect 

18 to waivers relating to the provisions described 

19 in subparagraph (I) of such paragraph; and 

20 ‘‘(E) the Secretary of Labor with respect 

21 to waivers relating to the provisions described 

22 in subparagraph (J) of such paragraph. 

23 ‘‘(4) SPECIFIED FEDERAL HEALTH PROGRAM.— 

24 The term ‘specified Federal health program’ means 

25 all of the following programs: 


amozie on DSK3GDR082PROD with BILLS
28 

•HR 6097 IH

1 ‘‘(A) The Medicare program under title 

2 XVIII of the Social Security Act. 

3 ‘‘(B) The Medicaid program under title 

4 XIX of the Social Security Act. 

5 ‘‘(C) The Children’s Health Insurance Pro6 gram under title XXI of the Social Security 

7 Act. 

8 ‘‘(D) The Federal Employees Health Bene9 fits Plan under chapter 89 of title 5 of the 

10 United States Code. 

11 ‘‘(E) Medical coverage under chapter 55 of 

12 title 10, United States Code, including coverage 

13 under the TRICARE program. 

14 ‘‘(F) An Exchange established under this 

15 subtitle. 

16 ‘‘(G) Subsidies under section 1402. 

17 ‘‘(H) Tax credits under sections 36B and 

18 45R of the Internal Revenue Code of 1986.’’. 

19 (b) CLERICAL AMENDMENT.—The item in the table 

20 of contents in section 1(b) of the Patient Protection and 

21 Affordable Care Act relating to section 1332 is amended 

22 to read as follows: 

‘‘Sec. 1332. Waiver for State universal health care.’’. 

23 (c) CONTINUATION OF CURRENT LAW FOR CURRENT

24 WAIVERS AND WAIVER APPLICATIONS.— 


amozie on DSK3GDR082PROD with BILLS
29 

•HR 6097 IH

1 (1) IN GENERAL.—Subject to paragraph (2), in 

2 the case of a State that has applied to the Secretary 

3 of Health and Human Services for a waiver under 

4 section 1332 of the Patient Protection and Afford5 able Care Act (42 U.S.C. 18052), as in effect before 

6 the enactment of this Act, for plan year 2018, such 

7 section 1332 shall continue to apply to such applica8 tion and to any waiver under such application for 

9 subsequent plan years. 

10 (2) TRANSITION TO NEW WAIVER LAW.—Noth11 ing in paragraph (1) shall be construed as pre12 venting a State described in such paragraph from 

13 withdrawing an application described in such para14 graph (or requesting the Secretary to terminate an 

15 approved waiver referred to in such paragraph) for 

16 plan year 2019 or a subsequent plan year and subse17 quently applying for a waiver under section 1332 of 

18 the Patient Protection and Affordable Care Act, as 

19 amended by subsection (a), for such a plan year. 

Æ 


amozie on DSK3GDR082PROD with BILLS